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How Would You Answer This Casper Question?


thsc

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I took a stab at this on Word, but the forum won't let me copy and paste. But in summary, I'd do the surgery. I'm assuming there is at least a moderate chance of success, so if the patient fully understands the risks involved, which it appears that he does, then I don't have an issue with doing it. The patient better understands the cost of living with the condition better than his doctor, so if he feels that risks are worth it, I believe that it would be unethical to deny him the surgery.

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I took a stab at this on Word, but the forum won't let me copy and paste. But in summary, I'd do the surgery. I'm assuming there is at least a moderate chance of success, so if the patient fully understands the risks involved, which it appears that he does, then I don't have an issue with doing it. The patient better understands the cost of living with the condition better than his doctor, so if he feels that risks are worth it, I believe that it would be unethical to deny him the surgery.

I agree with you, but I'm wondering if there is a legal obligation for the doctor to perform the surgery if he doesn't want to. In a life-saving situation, where a course of treatment has a significant possibility of working, the doctor can't legally turn down a patient, but since the empirical evidence doesn't suggest this here, my understanding is that he can say no if he wants to. 

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I'm not sure what the legal implications are, and I don't think you would be expected to bring them into a casper answer. But it would definitely be fine to do so, just make sure they're correct!

 

In this case, if you refuse, you're clearly breaking autonomy, with the justification that the risk of harming the patient did not outweigh the possible benefits. This is fine in certain situations, but here I think that since the patient seems to have weighed the risks and benefits himself, you should follow his wishes. This is assuming that the chance of surgery isn't ridiculously low, in which case it would be a waste of time and resources.

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I'm not sure what the legal implications are, and I don't think you would be expected to bring them into a casper answer. But it would definitely be fine to do so, just make sure they're correct!

 

In this case, if you refuse, you're clearly breaking autonomy, with the justification that the risk of harming the patient did not outweigh the possible benefits. This is fine in certain situations, but here I think that since the patient seems to have weighed the risks and benefits himself, you should follow his wishes. This is assuming that the chance of surgery isn't ridiculously low, in which case it would be a waste of time and resources.

 

There is also the aspect of negative vs positive rights. A patient is allowed to refuse a treatment or accept a treatment, but he is not allowed to ask for any treatment he wants (for example a patient can't demand to be given antibiotics). I haven't read this case, but if the surgeries chance is so ridiculously low and you would not feel comfortable doing the procedure, I think you could send the patient for a second opinion with another surgeon who could possibly do the surgery. That being said, if this is a treatment that is viable then I think the patient has the right to his autonomy in balancing the good and the bad of having the surgery. As long as the patient is competent, understands the risks and benefits, then it is the patients choice....assuming that the surgery is something which would normally be done in this type of situation.

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I took a stab at this on Word, but the forum won't let me copy and paste. But in summary, I'd do the surgery. I'm assuming there is at least a moderate chance of success, so if the patient fully understands the risks involved, which it appears that he does, then I don't have an issue with doing it. The patient better understands the cost of living with the condition better than his doctor, so if he feels that risks are worth it, I believe that it would be unethical to deny him the surgery.

I disagree. The way it sounds, the surgery's futile, there's a good chance he might die because of his heart condition and the patient is desperate. What if a patient with epilepsy said "just cut me open and poke around my brain a little doc, maybe a hemispherectomy would do me some good"? A patient being mentally sound doesn't mean you should follow through with all of their requests, even if you're legally protected. 

I'd refer him to a psychologist for the marriage and life problems and a pain management specialist. He's probably got a lot more options than he's aware of. If the pain is reducing his quality of life then risking paralysis or death will only make things worse.

My rule of thumb: would you do this to your dad? If not, don't do it to another person's dad.

 

Also "you're breaking the patient's autonomy" doesn't apply here. "your right to swing your fist ends where my nose begins" kinda thing

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I disagree. The way it sounds, the surgery's futile, there's a good chance he might die because of his heart condition and the patient is desperate. What if a patient with epilepsy said "just cut me open and poke around my brain a little doc, maybe a hemispherectomy would do me some good"? A patient being mentally sound doesn't mean you should follow through with all of their requests, even if you're legally protected. 

I'd refer him to a psychologist for the marriage and life problems and a pain management specialist. He's probably got a lot more options than he's aware of. If the pain is reducing his quality of life then risking paralysis or death will only make things worse.

My rule of thumb: would you do this to your dad? If not, don't do it to another person's dad.

 

Also "you're breaking the patient's autonomy" doesn't apply here. "your right to swing your fist ends where my nose begins" kinda thing

Hahaha....I died after reading that quote LOL. That's a winning response right there lol. 

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I agree with you, but I'm wondering if there is a legal obligation for the doctor to perform the surgery if he doesn't want to. In a life-saving situation, where a course of treatment has a significant possibility of working, the doctor can't legally turn down a patient, but since the empirical evidence doesn't suggest this here, my understanding is that he can say no if he wants to. 

 

There is definitely no legal obligation

 

 

Edit: For reference, I've discussed this particular case with an MD, DDS, and DPM. None of them would have performed the surgery.

 

Edit 2: Read the questions. They can't sue the doctor

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There is definitely no legal obligation

 

 

Edit: For reference, I've discussed this particular case with an MD, DDS, and DPM. None of them would have performed the surgery.

 

Edit 2: Read the questions. They can't sue the doctor

 

They can sue, but they probably won't win :P

 

So every single specialist you talked to would decline the surgery then? Did they go into detail as to why, other than the explanation given in the prompt?

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They can sue, but they probably won't win :P

 

So every single specialist you talked to would decline the surgery then? Did they go into detail as to why, other than the explanation given in the prompt?

Regarding the legal ramifications, I think they could potentially sue the doctor if he had made a huge mistake that should not have been made and was not a manifestation of the complications inherent in the surgery; I think this would be a valid basis for a suit. However, if it was an issue that resulted from the complex nature of the case, then the patient's suit obviously would have no merit. That was my thinking. 

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Important thing to remember is that you want to try to reach an agreement with the patient. Make sure you fully understand his situation and why he wants the surgery despite the risks, and make sure he fully understands the risks. Obviously, reaching an agreement might not be possible, but in the end you're under no obligation to perform the surgery. You should refer him to another surgeon though. If he's willing to accept the risks of surgery but perceives the additional risk of not having the top surgeon too much, he probably doesn't understand the risks of the surgery. 

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They can sue, but they probably won't win :P

 

So every single specialist you talked to would decline the surgery then? Did they go into detail as to why, other than the explanation given in the prompt?

They can try and sue, but they will lose if it even makes it to court

 

And yes, everyone would decline the surgery that I talked to. Their reasoning was basically that it's up to them if they want to perform it, and in their opinion the pros do not outweigh the cons. They didn't even have to think about it either. All three instantly said no.

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There is definitely no legal obligation

 

 

Edit: For reference, I've discussed this particular case with an MD, DDS, and DPM. None of them would have performed the surgery.

 

Edit 2: Read the questions. They can't sue the doctor

I'll use your analogy.There is a way you drive in real life and there is a way you drive during your license exam. I asked a few doctors before my interviews last year some questions and their answers were more about "driving in real life", whereas during your MMI, you need to "drive for the license exam" when you talk. I really don't think those people give the best advice for CASPER and MMI. MMI and CASPER are more about testing your thought process, if you're able to consider different perspectives rather than just point blank 1 sided decisions.

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I'll use your analogy.There is a way you drive in real life and there is a way you drive during your license exam. I asked a few doctors before my interviews last year some questions and their answers were more about "driving in real life", whereas during your MMI, you need to "drive for the license exam" when you talk. I really don't think those people give the best advice for CASPER and MMI. MMI and CASPER are more about testing your thought process, if you're able to consider different perspectives rather than just point blank 1 sided decisions.

 

I agree, which is why you can argue against using CASPer/MMI for admissions purposes... but I don't really want to get into that

 

For most things they're pretty good evaluations

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